The goal of the proposed research is to extend an innovative and successful nurse-delivered feeding intervention for very preterm infants (VP) to one delivered by mothers. Up to one-third of VP infants (d30 weeks gestational age) will develop significant feeding problems during early childhood. Difficulties begin when the infant is learning how to feed orally. Impaired pulmonary functioning limits the ability of the VP infant to consistently coordinate breathing and swallowing, thus creating the conditions for disrupted breathing and fluid threats to the airway. These in turn, affect the infant's quality of sucking and behavioral responses. As a consequence, VP infants demonstrate poor endurance and early cessation of feeding, poor fluid management with aspiration risk, periods of behavioral distress, and unstable oxygenation and heart rate. The skills their mothers need to deal with these challenges are often unexpected and more complex than anticipated. To address feeding challenges for both infants and mothers, the Co-Regulated Feeding Intervention (CoReg) was developed. CoReg includes nurse guidance of the mother to provide postural support, preparation of the infant pre-feeding, initiation based on infant readiness, minimization of movement during feeding and burping, regulation of milk flow and breathing opportunities, and providing rest periods in response to infant skill at organizing the suck, swallow, breathe sequence. An innovative component of the intervention is use of the audio trainer(c), a small microphone placed over the infant's larynx to sensitize the mother to the infant's breathing and swallowing rhythms. The proposed study meets NINR's goal to develop biobehavioral intervention strategies to optimize health of vulnerable populations. The CoReg intervention protocol for guiding mothers to provide the intervention will be refined and a pilot study will be conducted using a sequential cohort design. The specific aims of the pilot study are to evaluate the feasibility and acceptability of the intervention for mothers, the research nurse-guide's ability to execute the intervention with mothers, and the feasibility of the data collection procedures. In addition, the magnitude of the effect of the intervention on maternal feeding response (co-regulation feeding strategies), infant feeding regulation (behavioral organization, fluid management, work of breathing, physiologic stability), and infant feeding outcomes (feeding skill development, growth, and length of hospitalization) will be determined. We will explore the contributions of maternal characteristics (education, age, experience in feeding, worry about the child's health, illness-related stress, and depressive symptoms) and infant characteristics (gestational age, severity of lung disease, and neurodevelopment risk) on the efficacy of the intervention. Data analyses will include qualitative and descriptive analyses and linear regression and linear mixed modeling. The proposed study will provide a needed evidence base for guiding mothers to feed the most difficult-to-feed infants in neonatal care. Once fully tested, CoReg, with its use of the audio trainer(c), can be integrated into current neonatal care settings. PUBLIC HEALTH RELEVANCE: Cost of care for very preterm infants represents 24% of all infant care costs;about $3 billion is spent on their care each year. Prolonged hospitalization due to feeding problems is common and about 33% will develop significant feeding problems after discharge. This project uses a new innovative technology and the guidance of a nurse to assist mothers of very preterm infants learn about their infant's feeding difficulties and select effective feeding strategies that will help their infants remain calm during feeding, feed more safely, develop feeding skills earlier, improve growth, and allow the infant to be discharged to their home sooner. The proposed research will provide a needed evidence base for guiding mothers to feed the most difficult-to-feed infants in neonatal care and advance the current practice of cue-based neonatal feeding care for very preterm infants.